Provider Demographics
NPI:1083442065
Name:FRANCIS, TRACIE (LMT)
Entity type:Individual
Prefix:
First Name:TRACIE
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S YORK ST STE 213
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3432
Mailing Address - Country:US
Mailing Address - Phone:773-899-3236
Mailing Address - Fax:
Practice Address - Street 1:116 S YORK ST STE 213
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3432
Practice Address - Country:US
Practice Address - Phone:773-899-3236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227023194225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist